Medical Billing

Lecture: Overview of the U.S. healthcare system, medical terminology, compliance, ethics, and healthcare research resources.

Practical: Exercises on navigating healthcare references, coding resources, and compliance documentation.

Lecture: HMOs, PPOs, EPOs, Medicare, Medicaid, commercial insurance plans, and reimbursement structures.

Practical: Compare insurance plan types and analyze how payer differences affect billing processes.

Lecture: Patient demographics, eligibility verification, HIPAA compliance, and registration accuracy.

Practical: Simulated patient registration and insurance verification case exercises.

Lecture: ICD-10-CM coding structure, conventions, guidelines, and diagnostic coding fundamentals.

Practical: Coding exercises using real-world diagnosis scenarios and documentation review.

Lecture: CPT coding fundamentals and accurate reporting of medical procedures and services.

Practical: Practice assigning CPT codes based on clinical procedure documentation.

Lecture: HCPCS Level II coding for supplies, equipment, outpatient services, and non-physician procedures.

Practical: HCPCS coding exercises involving medical supplies and outpatient billing cases.

Lecture: NCDs, LCDs, medical necessity policies, diagnosis-to-procedure linking, and payer requirements.

Practical: Case-based exercises on linking diagnosis codes to procedures for reimbursement.

Lecture: Professional and institutional claim forms, billing workflows, documentation sourcing, and common claim errors.

Practical: Complete CMS-1500 and UB-04 claim forms using sample patient cases.

Lecture: Denial management, payment posting, appeals, collections, and revenue cycle integrity.

Practical: Analyze denied claims and perform follow-up and appeals exercises.

Lecture: Medicare, Medicaid, Tricare requirements, reimbursement guidelines, and payer processes.

Practical: Billing exercises using government payer claim scenarios and compliance rules.